Increased N200 and P300 latencies in cognitively impaired elderly carrying ApoE ε-4 allele.

OBJECTIVE: To compare the results of neuropsychological tests, evoked potentials N200 and P300 and polymorphisms of ApoE and BDNF rs6265 between patients with normal cognition and those with mild cognitive impairment (MCI) and Alzheimer's dementia (AD). METHODS: This is a cross-sectional study of elderly individuals with normal cognition and those with MCI and AD, who were submitted to evoked potential tests (N200 and P300) by means of hearing stimuli based on the auditory oddball paradigm. Genotyping was obtained by using the real-time PCR technique. RESULTS: Sixty-five patients were evaluated as follows: 14 controls, 34 with MCI and 17 with AD. N200 latency and P300 latency and amplitude were not associated with MCI and AD diagnosis. Patients with cognitive impairment (MCI or AD) showed increase in the latencies of P300 and N200. BNDF gene was not associated with cognitive impairment. CONCLUSION: Latencies of N200 and P300 increased in cognitively impaired patients with the presence of ApoE ε-4 allele.

Vestibular evoked myogenic potential (VEMP) with galvanic stimulation in normal subjects.

INTRODUCTION: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. AIM: To describe VEMP generated by GVS. METHODS: In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. RESULTS: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. CONCLUSION: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Potencial evocado miogenico vestibular (VEMP) com estimulo galvanico em individuos normais / Vestibular evoked myogenic potential (VEMP) with galvanic stimulation in normal subjects

Introdução: O potencial evocado miogênico vestibular (VEMP) gerado por estimulação galvânica (GVS) reflete uma resposta vestíbulo-espinhal. A resposta obtida no músculo sóleo é bifásica, primeiro com componente de curta latência (CL), em torno de 60 ms, e depois com o de média latência (ML), em torno de 100 ms. O componente de CL associa-se à função otolítica (sáculo e utrículo), e o de ML, aos ductos semicirculares. Objetivo: Descrever os valores de referência do VEMP com estimulação galvânica em indivíduos normais. Casuística e método: Forma de estudo transversal; o VEMP foi gerado por GVS de 2mA/400 ms, aplicada bilateralmente, sob frequência de 5-6 ms. Testou-se resposta no músculo sóleo de 13 sujeitos saudáveis, com idade média de 56 anos. Os sujeitos permaneceram de pé, com cabeça girada contralateral ao GVS aplicado na mastoide. Na configuração catodo direito, anodo esquerda, 30 GVS foi aplicado, seguidos de mais 30 com configuração inversa. Os componentes de CL e de ML da resposta vestibular foram analisados. Resultado: Os componentes de CL e de ML foram semelhantes em ambas as pernas. O valor médio de CL foi 54 ms, e o de ML, 112 ms. Conclusão: Os componentes de CL e de ML do VEMP solear foram replicáveis, sendo medidas úteis de função do trato vestíbulo-espinhal. .

Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. Aim: To describe VEMP generated by GVS. Methods: In this cross-sectional clinical study, VEMP was generated by 2mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function. .

Abordagem funcional e centrada no cliente na reabilitação de idoso com demência de Alzheimer avançada - relato de caso / Functional approach and centered-client pratic in rehabilitation of severe Alzheimer disease's older adult - case report

A Doença de Alzheimer (DA) é uma doença cerebral degenerativa que compromete a cognição e a realização das atividades de vida diária (AVDs). Os tratamentos disponíveis apenas minimizam os déficits cognitivos e as alterações de comportamento, sendo necessárias medidas que melhorem a qualidade de vida de pacientes e cuidadores. OBJETIVOS: Apresentar os resultados da intervenção domiciliária de TO usando abordagem funcional e centrada no cliente associada ao tratamento farmacológico em idoso com DA avançada. DESCRIÇÃO DO CASO CLÍNICO: Paciente de 64 anos, sexo masculino, previamente hígido, que, em 2004, apresentou piora progressiva das funções cognitivas, sendo diagnosticado com provável DA. Em 2006, foi avaliado pelo serviço de Terapia Ocupacional (TO) do Hospital Socor/BH, apresentando baixos escores nos testes cognitivos e funcionais (Mini-Mental; Testes de Fluência Verbal e do Relógio; Índice de Katz; Medida Canadense do Desempenho Ocupacional - COPM e Time diary). Observou-se dependência total em AVDs, grande insatisfação da cuidadora relacionados às alterações comportamentais apresentadas pelo paciente (alucinação, perambulação, agitação e inversão do ciclo sono-vigília), interação social reduzida e dependência crescente em AVDs básicas, além da desorganização da rotina ocupacional. Foram realizadas três sessões semanais no domicílio, com duração de 1 hora e acompanhamento pela neurologia e clínica médica. Observou-se melhora nos testes após três meses de tratamento, sustentada por 8 meses, contrapondo-se a evolução descrita na literatura sobre a progressão inexorável da incapacidade funcional. O Índice de Katz, ao contrário da COPM e time diary, não descreveu a melhora qualitativa observada no desempenho das AVDs. CONCLUSÃO: A intervenção domiciliária de TO associada ao tratamento medicamentoso mostrou efeitos significativos no caso apresentado.

Alzheimer's disease (AD) is a degenerative brain disease that affects cognition and perform activities of daily living (ADLs). The treatments available only minimize the cognitive deficits and behavioral changes, being necessary measures to improve the quality of life of patients and caregivers. OBJECTIVES: To present the results of interventions using Ocupational Therapy at home and functional approach focusing on customer conjunction with pharmacological treatment in elderly patients with advanced DA. DESCRIPTION OF THE CASE: A 64 year old male, previously healthy, who in 2004 showed progressive worsening of cognitive function, being diagnosed with probable AD. In 2006 it was assessed by the department of Occupational Therapy (OT), Hospital Socor-BH, showing low scores on cognitive tests and functional (Mini-Mental, Verbal Fluency Test and the Clock; Katz Index, the Canadian Occupational Performance Measure - Time diary and COPM). There is total dependence in ADL, caregiver's great dissatisfaction about the behavioral changes shown and the need for total aid to feed,bath and clothing, plus the disruption of routine occupational. They performed three sessions per week at home, lasting 1 hour and monitored by the neurology and internal medicine. An improvement in the tests after three months of treatment, sustained for 8 months, opposing the developments described in the literature about the inexorable progression of disability. The Katz Index, unlike the time and COPM diary, did not describe the observed qualitative improvement in the performance of ADLs. CONCLUSION: The home of OT intervention related to drug treatment showed significant effects in the case present.

Validity of the monothermal caloric testing when compared to bithermal stimulation.

BACKGROUND: the use of monothermal caloric testing as a screening tool for vestibular asymmetry has been considered as an alternative to bithermal caloric testing. AIM: to evaluate the effectiveness of monothermal stimulation when compared to bithermal stimulation in the diagnosis of labyrinth asymmetry. METHOD: the results of 389 vectoelectronystagmography, performed between 1998 and 2007, were analyzed. Monothermal stimulation at 30°C and 44°C with unilateral weakness (UW) cut-off at 20% and 25% was compared to bithermal stimulation with cut-off at 25% (gold standard). The analysis was aimed at finding which kind of monothermal caloric test (30°C or 44°C) and which kind of cut-off (20% or 25%) presented the highest specificity and sensitivity values in comparison with bithermal caloric testing. RESULTS: sensitivity and specificity of monothermal caloric tests were: 84% and 80%, at 30°C with UW at 20%; 78% and 90%, at 30°C with UW at 25%; 81% and 78%, at 44°C with UW at 20%; 76% and 85%, at 44°C with UW at 25%. CONCLUSION: monothermal caloric testing with 30°C stimulus presented the highest sensibility and specificity values in comparison to the results obtained with bithermal stimulation. However, no significant difference was observed between such values and those obtained with 44°C stimulus. In all of the analyses, monothermal testing presented low sensitivity. Thus, the abnormal result of bithermal caloric testing might be seen as normal in monothermal stimulation. The use of monothermal testing as a screening tool is better recommended for individuals whose medical history suggests a low probability of vestibular disease.

Validade da prova calórica monotermal em comparação à estimulação bitermal / Validity of the monothermal caloric testing when compared to bithermal stimulation

Background: the use of monothermal caloric testing as a screening tool for vestibular asymmetry has been considered as an alternative to bithermal caloric testing. AIM: to evaluate the effectiveness of monothermal stimulation when compared to bithermal stimulation in the diagnosis of labyrinth asymmetry. Method: the results of 389 vectoelectronystagmography, performed between 1998 and 2007, were analyzed. Monothermal stimulation at 30oC and 44ºC with unilateral weakness (UW) cut-off at 20 percent and 25 percent was compared to bithermal stimulation with cut-off at 25 percent (gold standard). The analysis was aimed at finding which kind of monothermal caloric test (30oC or 44oC) and which kind of cut-off (20 percent or 25 percent) presented the highest specificity and sensitivity values in comparison with bithermal caloric testing. Results: sensitivity and specificity of monothermal caloric tests were: 84 percent and 80 percent, at 30°C with UW at 20 percent; 78 percent and 90 percent, at 30°C with UW at 25 percent; 81 percent and 78 percent, at 44°C with UW at 20 percent; 76 percent and 85 percent, at 44°C with UW at 25 percent. Conclusion: monothermal caloric testing with 30°C stimulus presented the highest sensibility and specificity values in comparison to the results obtained with bithermal stimulation. However, no significant difference was observed between such values and those obtained with 44°C stimulus. In all of the analyses, monothermal testing presented low sensitivity. Thus, the abnormal result of bithermal caloric testing might be seen as normal in monothermal stimulation. The use of monothermal testing as a screening tool is better recommended for individuals whose medical history suggests a low probability of vestibular disease.

Tema: a estimulação calórica monotermal tem sido considerada como alternativa à prova calórica bitermal para triagem das assimetrias vestibulares. Objetivo: avaliar a confiabilidade da estimulação monotermal em relação à bitermal para o diagnóstico das assimetrias labirínticas. Método: avaliaram-se 389 resultados de vectoelectronistagmografia realizados entre 1998 e 2007. A estimulação monotermal de 30ºC e 44ºC com pontos de corte de predomínio labiríntico (PL) em 20 por cento e em 25 por cento foi comparada à bitermal com ponto de corte em 25 por cento (padrão ouro). Na análise, interessou encontrar qual foi à prova monotemal (30°C ou 44°C) e com qual ponto de corte (20 por cento ou 25 por cento) que apresentou os valores mais elevados de sensibilidade e especificidade quando comparada à prova bitermal. Resultados: a sensibilidade e especificidade da prova monotermal foram respectivamente de: 84 por cento e 80 por cento, a 30°C com PL em 20 por cento; 78 por cento e 90 por cento, a 30°C com PL em 25 por cento; 81 por cento e 78 por cento, a 44°C com PL em 20 por cento; 76 por cento e 85 por cento, a 44°C com PL em 25 por cento. Conclusão: a prova monotermal com estimulo a 30°C apresentou valores mais elevados de sensibilidade e especificidade quando comparada a bitermal. Contudo, não se observou diferença significativa em relação aos valores observados com estímulo a 44°C. Em todas as análises, a prova monotermal apresentou a limitação da baixa sensibilidade, de modo que testes alterados pela bitermal podem passar como normais pela prova monoternal. Ao se decidir pela realização da prova monotermal como triagem, deve-se realizá-la em indivíduos com menor probabilidade de estar com doença vestibular, a partir da história clínica.

Fatores que predispõem ao declínio funcional em idosos hospitalizados / Predictors of functional decline in hospitalized elderly patients

Introdução: O aumento da expectativa de vida é uma realidade mundial e determinamaior prevalência de doenças crônicas e maior demanda pelos serviços desaúde, incluindo os hospitalares. Atualmente, estudos têm focalizado o declíniofuncional e suas consequências ? demanda por recursos materiais e humanos,institucionalização e hospitalização. O objetivo foi a revisão crítica da literaturadisponível sobre os fatores de risco associados ao declínio funcional em idososhospitalizados. Metodologia: Pesquisa nas bases de dados MEDLINE, LILACS eSciELO, nos idiomas inglês e português, entre 2000 e 2007, utilizando as palavras-chave hospital, elderly, functional status, aged e functional decline e referências bibliográficasdos artigos selecionados. Resultados: Satisfizeram os critérios de inclusão31 publicações. Após leitura crítica do abstract, os 15 artigos mais relevantesforam selecionados. Conclusão: O declínio funcional pode ocorrer antes, durantee/ou após a hospitalização. Idade avançada, comprometimento funcional prévio,déficit cognitivo, iatrogenias, gravidade da condição clínica e histórico dequedas foram os fatores de risco mais citados. A capacidade funcional, comomarcador de saúde desse grupo, merece maior investigação.

Introduction: The increase in life expectancy is a global reality and determinesthe highest prevalence of chronic diseases and greater demand for healthservices, including hospitals. Currently, studies have focused on functionaldecline and its consequences - the demand for material and human resources,institutionalization and hospitalization. This paper aimed to critically reviewthe available literature on the risk factors associated with functional declinein hospitalized elderly people. Methodology: Search the databases MEDLINE,LILACS and SciELO, in English and Portuguese between 2000 and 2007,using the key words hospital, elderly, functional status, aged and functionaldecline and references of selected articles.Results: Thirty-one publications met the inclusion criteria. After criticalreading of the abstract, the 15 most relevant papers were selected. Conclusion:The functional decline can occur before, during and / or after hospitalization.Advanced age, prior functional impairment, cognitive impairment,iatrogenic, severe medical condition and history of falls were the risk factorsmost often cited. Functional capacity, as a marker of health in this group,deserves further investigation.

[Presbyvertigo as a cause of dizziness in elderly]. / Presbivertigem como causa de tontura no idoso.

BACKGROUND: dizziness is a frequent complaint in the geriatric population and has a negative impact in the life quality of these individuals. AIM: to correlate the types of dizziness and alterations in the caloric test and to verify the frequency of presbyvertigo in an elderly population with dizziness. METHOD: The records of 132 patients aged over 60 and with balance disturbance were reviewed. These patients were evaluated in the Otoneurology Service of the Clinical Hospital of the Federal University of Minas Gerais between the years of 1998 and 2007. The variables considered for analysis were: epidemiologic data, clinical history, associated diseases and the result of the caloric test. Patients with positional and central vertigo were excluded from the analysis. RESULTS: The research sample consisted of 120 patients, with an average age was of 70 years, being 71% (n=87) of sample women. Vertigo with the duration of a few minutes and of a daily frequency was the most frequent type of dizziness. In relation to the caloric test, normal results were observed in 73% of the sample. Altered results included unilateral weakness (14%), bilateral weakness (10%) and hyperactive caloric response (3%). Correlating the caloric test with the type of dizziness, bilateral weakness was associated with postural instability (p=0.006; IC=2 - 419). CONCLUSION: dizziness in elderly has many causes. Bilateral weakness of the vestibular function can be related to presbyvertigo and must be considered in aged individuals who present unbalance. Metabolic, psychiatric, disautonomic, orthopedic, visual and proprioceptive disturbances may be the cause of dizziness in aged individuals who present normal vestibular evaluation.

Presbivertigem como causa de tontura no idoso / Presbyvertigo as a cause of dizziness in elderly

INTRODUÇÃO: tontura é queixa freqüente na população geriátrica e interfere na qualidade de vida desses indivíduos. OBJETIVO: descrever as causas de tontura, correlacionar sintomas e alterações na prova calórica e verificar o impacto da presbivertigem como fator primário de tontura em população de idosos. MÉTODO: revisão do prontuário de 132 pacientes com mais de 60 anos e distúrbio do equilíbrio corporal, atendidos no ambulatório de Otoneurologia do Hospital das Clínicas da UFMG, no período de 1998 a 2007. As variáveis analisadas foram: dados epidemiológicos, história clínica, doenças associadas e resultado da prova calórica. Casos de vertigem de posição e suspeita de lesão central foram excluídos da análise. RESULTADOS: A amostra constou de 120 pacientes. A idade média foi de 70 anos, sendo 87 (71 por cento) mulheres. Dentre os tipos de tontura, vertigem de alguns minutos de duração e freqüência diária foi mais freqüente. Em relação ao resultado da prova calórica, exame normal foi observado em 73 por cento e, dentre os resultados alterados, hiporreflexia bilateral (presbivertigem) foi observada em 8 por cento. Correlacionando-se com o tipo de tontura, hiporreflexia bilateral associou-se com instabilidade postural (p = 0,006; IC = 2 - 419). CONCLUSÃO: tontura no idoso tem causa multifatorial. Perda da função vestibular periférica pode estar relacionada à presbivertigem e deve ser considerada em pessoas idosas com desequilíbrio. Distúrbios metabólicos, psíquicos, disautonômicos, ortopédicos, visuais e de propriocepção podem ser causa de tontura em idosos com exame vestibular normal.

BACKGROUND: dizziness is a frequent complaint in the geriatric population and has a negative impact in the life quality of these individuals. AIM: to correlate the types of dizziness and alterations in the caloric test and to verify the frequency of presbyvertigo in an elderly population with dizziness. METHOD: The records of 132 patients aged over 60 and with balance disturbance were reviewed. These patients were evaluated in the Otoneurology Service of the Clinical Hospital of the Federal University of Minas Gerais between the years of 1998 and 2007. The variables considered for analysis were: epidemiologic data, clinical history, associated diseases and the result of the caloric test. Patients with positional and central vertigo were excluded from the analysis. RESULTS: The research sample consisted of 120 patients, with an average age was of 70 years, being 71 percent (n=87) of sample women. Vertigo with the duration of a few minutes and of a daily frequency was the most frequent type of dizziness. In relation to the caloric test, normal results were observed in 73 percent of the sample. Altered results included unilateral weakness (14 percent), bilateral weakness (10 percent) and hyperactive caloric response (3 percent). Correlating the caloric test with the type of dizziness, bilateral weakness was associated with postural instability (p=0.006; IC=2 - 419). CONCLUSION: dizziness in elderly has many causes. Bilateral weakness of the vestibular function can be related to presbyvertigo and must be considered in aged individuals who present unbalance. Metabolic, psychiatric, disautonomic, orthopedic, visual and proprioceptive disturbances may be the cause of dizziness in aged individuals who present normal vestibular evaluation.